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Biomedical subjects

J Vilska

Publications and source records attributed to J Vilska.

At least 19 recordsLinked to original sources
PubMed1993

Hospitalizations due to poisonings in Finland.

Poisonings constitute an important category of causes for admission of patients to the emergency room. The annual incidence of hospitalized poisonings in Finland over 2 years (1987-1988) was 11.7 for a population of 10,000 according to the Hospital Discharge Register; it was 8.7/10,000 for drugs and 3.0/10,000 for non-drugs. Children under 6 years of age were most frequently hospitalized because of poisoning (16.9/10,000), followed by adults aged 25-44 years (14.8/10,000). The leading causes of poisoning or chemical injury in children were undefined non-drug poisonings; plants, berries and mushrooms mistaken for edible food, and corrosives. In patients aged 6 years or more, mainly adults, the leading causes were psychotropic drugs, ethanol, and cardiovascular drugs. The pattern of poisoning has changed markedly during the 1980s; the rate of psychotropic and sedative drug poisoning admissions have increased from 35 to 47%, and poisonings due to analgesics have also increased significantly. Conversely, poisonings caused by cardiovascular drugs and antibiotics, solvent poisonings and incidents caused by corrosives have decreased significantly (p < 0.001).

Adolescent↗
PubMed1993

Alcohol intoxication in hospitalized young teenagers.

The scientific literature concerning alcohol intoxication is enormous. However, less is known of alcohol-induced disturbances in children and adolescents and most of those reports concern cases of hypoglycemia in children under five years of age. We studied the clinical status and chemistry, especially acid-base balance, in 36 young teenagers treated at hospital for alcohol intoxication. On physical examination 6 patients were somnolent, 18 were comatose and 12 were in deep coma. The impairment of consciousness was directly proportional to the blood ethanol concentration. Acidosis was a central finding, and it was caused by a combination of respiratory and metabolic factors (a high blood PCO2 and a low base excess; r = 0.97, p < 0.001); the finding of respiratory acidosis dominated. Base excess correlated negatively with beta-hydroxybutyrate and lactate, as expected. All the metabolic products measured--acetate, beta-hydroxybutyrate and lactate--were significantly elevated compared with the control patients. No hypoglycemia was found. Prior treatment with intravenous glucose decreased vomiting and normalized the serum lactate concentration and PO2. Hypokalemia was the most common abnormality in serum electrolytes. In four patients the rate of fall of blood ethanol concentration was 2.8-3.3 mmol/h (0.13-0.15 g/l-1 h-1) and the mean acetate concentration was 0.8 mmol/l (SE 0.3). Biochemical disturbances in young teenage alcohol intoxicants resemble those previously found in adults. The severe toxicity by ethanol, manifesting in coma, occurs in lower blood alcohol concentrations in children than in adults.

Acetates↗
PubMed1993

Medical charcoal for a child's poisoning at home: availability and success of administration in Finland.

In a prospective study, 174 families were interviewed over the telephone to find out whether the treatment of their child's poisoning with medical charcoal was successfully completed. The majority (103; 59.2%) of the families had no charcoal at home. The mean delay in administration for those who had to obtain charcoal was 41.6 min; significantly longer than the 24.5 min taken for those who had charcoal at home (P < 0.001). The treatment succeeded in all but five of the 102 patients given charcoal at home. Thus for mild poisoning in young children, the administration of activated charcoal at home, under the guidance of a Poison Information Centre, could be a rapid and safe first-aid treatment. Presently the widespread unavailability of charcoal in the home in Finland causes an unnecessary delay in treatment that could be of clinical importance.

Accidents, Home↗
PubMed1991

Acid-base balance in alcohol users seen in an emergency room.

Over 10% of emergency room patients are diagnosed as having alcohol (6.0%) or drug intoxication. In the present study 196 alcohol intoxications treated in a hospital were studied retrospectively; 49.2% of the patients had abnormal acid-base values, alcoholics more often than non-alcoholics (p = 0.04). Mean blood ethanol concentration (BAC) was 310 mg/dl (SD 120); alcoholics had higher concentrations of alcohol. BAC was the higher the lower the serum pH was (p less than 0.002, r = -0.45). The deeper the coma the lower the serum pH (p less than 0.05) and the higher the BAC (p less than 0.0001). Respiratory acidosis (31.7%) was an important finding in those intoxicated. Metabolic acidosis (7.9%) could be explained by the presence metabolites of ethanol in the serum and by decreased extra-cellular fluid volume. Metabolic alkalosis related to vomiting and an extra-cellular fluid volume decrease was found in 7.9% of the patients. Respiratory alkalosis was a rare finding (1.6%). Hypokalemia (22.5%) and hypernatremia (15.3%) were the most important electrolyte changes. Chronic alcoholics had lower serum potassium than had non-alcoholics; 3.6% (n = 7) of the patients had to be intubated. Acid-base disturbances were frequent in adults with alcohol intoxication. Serum pH correlated well with the state of consciousness and the BAC.

Acid-Base Equilibrium↗
PubMed1990

Alcohol intoxication and psychosocial problems among children.

A drunken child is a common sight in the streets during weekends in Finland. An early episode of drunkenness may be an early sign of a serious tendency, or it may be an isolated incident. In this study 300 alcohol intoxications treated in hospital were examined. The underlying risk factors of the patients, their motives for drinking and their symptoms and signs were recorded. Underlying family problems were usual; in 45% of the cases the family was broken, in 36% the family had visited child guidance clinics, and in 31% of the families one parent was an alcoholic. The lower the mother's social group was, the higher the frequency of alcohol intoxication. Previous intoxications were reported in 9% of the cases. Most of the children's intoxications were experimental (49%); suicidal cases amounted to 8% and cases in which the child had been forced to drink amounted to 6%, and the rest of the patients belonged to the problem group and the mixed-motives group.

Adolescent↗
PubMed1988

Trimethoprim in the treatment of acute urinary tract infections in children.

In the first study to assess the effect of trimethoprim in the treatment of acute urinary tract infections in children, we compared it with sulphisoxazole. Eighteen girls, mean age 5.3 years, were treated with trimethoprim 6 mg/kg/day. Seventeen girls, mean age 5.0 years, treated with sulphisoxazole 150-200 mg/kg/day for 10 days served as controls. All infections were cured. Three patients in each group had reinfections during the 6 months of follow-up. In each group, one of the reinfections occurred within 2 weeks after the end of the treatment. One patient developed a rash from sulphisoxazole and so required drug change. No other adverse effects were observed. We conclude that trimethoprim is as effective as sulphisoxazole in the treatment of simple acute urinary tract infections of children and recommend it, in the dosage used, as an alternative first-choice drug, especially for patients who have had side effects from sulphonamides or nitrofurantoin.

Acute Disease↗
PubMed1982

Long-term outcome of primary nephrotic syndrome.

One hundred and fourteen children with primary nephrotic syndrome were followed up prospectively for periods of between 5 and 14 years. Urine samples from 94 of them became protein-free during the initial 8-week course of prednisone, and the outcome for these children was good: 74 of them have been free of symptoms for at least 3 years, 18 have had relapses during the last 3 years, and only one child still has proteinuria. All these children have normal renal function and blood pressure. One child died accidentally. Twenty children did not respond to the initial prednisone treatment. Thirteen of them had remissions later, of whom 2 have had relapses during the last 3 years. Seven were totally resistant to prednisone 4 of whom died in renal failure, the remaining 3 have persistent proteinuria with normal levels of creatinine; one has high blood pressure too. Remission during the initial treatment indicated a good prognosis, but two-thirds of the initial non-responders also fared well.

Adolescent↗
PubMed1981

Scoring of urinary findings as an aid in diagnosis for childhood urinary tract infection.

To improve diagnostic accuracy of urinary tract infection in infants and children a simple score is described. 213 patients with suspect urinary tract infection underwent a diagnostic work-up including 2 consecutive clean-voided urine samples, and a suprapubic bladder aspirate as a diagnostic reference. The uncentrifuged clean-voided urine specimens were scored separately for microscopic leucocyte and bacterial count as well as for quantitative bacterial culture. The scores obtained were added together and a diagnostic scheme was created. After this scheme had been tested in 50 consecutive symptomatic urinary tract infections, it was possible to start therapy in 48 patients following the microscopic examination of 2 consecutive clean-voided urine samples from each. Likewise, 44 of 50 asymptomatic urinary tract infections were diagnosed by this scheme, after the urine cultures had been obtained. The scheme may be a useful aid in diagnosing urinary tract infection in infants and children, in case of equivocal urinary findings in particular.

Bacteriuria↗
PubMed1981

The value of level diagnosis of childhood urinary tract infection in predicting renal injury.

252 infants and children were followed for 2 years after their first urinary tract infection. Each symptomatic infection was determined by simple laboratory examinations as upper pyelonephritic or lower urinary tract infection. I.v. urography was done at the beginning of the follow-up and 2 years later; micturating cystourethrography was taken after the third infection at the latest. Urological abnormalities were found in 26 patients (10%), and 12 subjects (5%) developed renal scars during the study. Patients, who had their first upper urinary tract infection before the age of 12 months, numbered 93, and 19 of them had urological abnormalities and 10 scars. Two renal scars occurred among the 71 subjects with their first pyelonephritic infection after the age of 12 months. No renal injury was detected in the 88 infants and children with lower symptomatic urinary tract infection or asymptomatic bacteriuria. The determination of the level of the infection may be a useful aid in detecting the harmful scar-forming urinary tract infections. Infants with a pyelonephritic infection are at high risk, and in need of an early urological evaluation.

Adolescent↗
PubMed1981

The length of antimicrobial therapy in upper vs. lower urinary tract infection of childhood.

235 infants and children were randomized to a 10-day and 42-day treatment group and followed-up for 12 months after their first urinary tract infection. The anatomical level of each symptomatic infection was determined using simple laboratory criteria. The two regimens prescribed were equally effective in eradicating the infection, but after the discontinuation of the 10-day treatment with sulfafurazole, 17 (23%) of 73 patients with their upper urinary tract infection experienced a recurrence within one month, as compared to only one (1) of 76 subjects in the 42-day therapy group. After the phase of early recurrence, there was no difference in recurrence rate between these groups. The early recurrences were associated with the patient's early age and a short duration of symptoms before therapy. The recurrence rate of first lower UTI after 10-day therapy was significantly lower than that after 42-day treatment. The duration of antimicrobial therapy for childhood urinary tract infection should be adjusted according to the patient's age and the anatomical level of the infection. 10-day treatment may not be sufficient to prevent early recurrence of pyelonephritic infections in infants under 6 months of age.

Female↗
PubMed1981

Henoch-Schönlein nephritis: long-term prognosis of unselected patients.

Progressive glomerulonephritis is the most serious feature of Henoch-Schönlein syndrome. In a series of 141 children with Henoch-Schönlein purpura 39 (28%) had abnormal urinary sediment for a duration of more than one month. This subgroup was followed up for 3.0 to 13.8 (mean 7.2) years. One child progressed to renal failure and 2 developed chronic glomerular disease. In this series most of the patients with Henoch-Schönlein syndrome and nephritis had a good prognosis.

Adolescent↗
PubMed1980

Renal pathology in congenital nephrotic syndrome of Finnish type: a quantitative light microscopic study on 50 patients.

The quantitative histopathological analysis was performed on 68 renal specimens of 50 children with congenital nephrotic syndrome of Finnish type (CNF). Thirty five of samples were biopsies and 33 were taken at autopsy. The kidneys of the CNF children were 2-3 times larger by weight than those of normal children. The renal histological picture varied greatly from one patient to another. The glomeruli of the CNF patients showed more often fibrotic lesions and mesangial hypercellularity than those of the normal infants, while immature glomeruli were seen more frequently in the controls than in CNF children. Tubular atrophy and tubular dilatations were also common histological feature in the CNF children. Glomerular fibrosis and tubulo-interstitial changes showed significant progression during the course of the disease while mesangial cell proliferation did not increase with age. The decreased tubular cell mass was replaced by interstitial tissue in the kidneys of older CNF infants. The proportion of the total glomerular volume to the volume of the whole kidney was about the same in CNF as in normal children. Because of the greater kidney size in CNF the absolute volume of the total glomerular mass is increased in this disease.

Biopsy↗
PubMed1979

Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation.

An unselected population of 8,954 children, age 8 to 15 years, was screened for hematuria. Four urine specimens from each were examined; microscopic hematuria was found in one or more specimens in 4.1%, and in two or more specimens in 1.1% of the children. The prevalence was not age or sex dependent. Those with two or more positive samples were re-examined twice during a half-year period: 33 had hematuria of 6 or more RBC/0.9 mm3, or more than 100,000 RBC/hour, on both occasions; renal biopsy performed on 28 of them revealed two cases of IgA-IgG nephropathy, one of focal segmental sclerosis, one of extracapillary glomerulonephritis, and one of possible hereditary nephritis. In 12 patients the biopsy was entirely normal; the rest showed equivocal changes. Co-existing proteinuria and the degree of hematuria correlated well with the severity of the morphologic alterations. Pathologic findings in microscopic hematuria seem to be less frequent than in hematuria in general; in most such patients, renal biopsy is probably not indicated. In some children the low-grade hematuria may merely represent the upper end of physiologic variation.

Adolescent↗
PubMed1979

Diagnostic value of symptoms and clean-voided urine specimen in childhood urinary tract infection.

In diagnosing urinary tract infection (UTI) the symptoms of 477 infants and children and the findings in their clean-voided urine specimens were evaluated. 322 patients were considered infected, when a bacterial culture of suprapubic aspirate was used as a diagnostic reference. No diagnosis was attempted on the basis of symptoms only. Numerous bacteria or greater than or equal to 200 leuc./mm3 in an uncentrifuged clean-voided urine specimen or greater than or equal to 10(5) bact./ml in quantitative bacterial culture were found in 59%, 42% and 81% of the infected symptomatic patients. The diagnostic accuracies of these indices were 88%, 94% and 95%, respectively. In asymptomatic patients the accuracies were considerably lower. Among these infected patients normal or equivocal isolated findings in the clean-voided urine specimens were frequently seen, and could not markedly be reduced by the various related factors, such as technique of urine collection, urine specific gravity or pH of urine. None of the above mentioned indices of the clean-voided urine specimens seems to be alone accurate and sensitive enough for diagnosing UTI, and therefore these should be used in combination. The advantage of immediately obtaining results supports the use of urine microscopy as a primary diagnostic method in symptomatic UTI of childhood in particular.

Child, Preschool↗
PubMed1979

Severe poisoning in a child caused by a small dose of clonidine.

A girl aged 1 year 9 months ingested a single tablet of 0.3 mg of clonidine. She became soon drowsy and unconscious with bradycardia and severe hypotension. Bradycardia was antagonized promptly by atropine, and blood pressure was corrected by giving intravenous fluids. The level of consciousness fluctuated for 6 to 8 hr from alertness to unconsciousness. Serum concentrations of clonidine were only about two times higher than the mean therapeutic values in adults in the treatment of hypertension. Thus small doses of clonidine seem to be potentially dangerous for small children.

Bradycardia↗